What does it mean and how reliable are death certificates
Every person who dies in the United States must have a death certificate completed. Many times that death certificate will list “natural causes” as the cause of death. However, that is not a medical diagnosis explains Virgina Malpractice Attorney Jeffrey and often death certificates are not accurate.
Death by natural causes is a catch all phrase that essentially means the person died of complications flowing from old age. A heart attack or other medical condition could qualify as a natural cause. In fact, Coronary Artery Disease (CAD) is one of the most common types of death by natural causes, with some 16% of all deaths being attributed to that cause. The second and third most common causes of a natural death include stroke and chronic obstructive pulmonary disease.
Where death occurs from some unnatural cause like suicide, neglect or medical malpractice, the death is not from natural causes. Unfortunately, it is not unusual for victims of neglect to have their death certificate reflect natural causes when in fact their death was due to a preventable event like an infection, pressure wound or fracture injury.
Where a patient dies in a nursing home typically the medical director of that nursing home will record the cause of death. In this writer’s experience, when a doctor affiliated with a nursing home completes the death certificate, he typically does not document a cause that incriminates the nursing home or assisted living facility. As such, its important to have an unaffiliated doctor complete the death certificate so that the cause bears some relationship to reality.
If you have a loved one who has sustained a hip fracture or is struggling to recover from a serious injury, like an infected pressure wound, it is important to inform the facility that you want to be notified immediately if the patient takes a turn for the worse. At that point you may want to request he/she be taken to the hospital which increases the chances that an accurate cause of death will be reflected on the death certificate. There are important issues to consider.
1. Should I contact an attorney?
If you think your loved one will die from a preventable injury that developed in a nursing home or assisted living facility, you should contact an experienced attorney as soon as possible. That attorney can advise you of your options and address the questions below. As most malpractice attorneys work on a contingency basis, it will not cost you anything to get some advice on this issue. My office routinely handles such inquiries. Phone 703-564-7318.
2. Where is the patient going to expire?
Whenever possible, you will be better served by having your loved one pass away in a hospital. Nursing home doctors who fill out death certificates are often conflicted and unlikely to put a cause of death down that implicates negligence on the part of the facility. Hospital physicians tend to be more objective, and they will also have the benefit of recent medical information, labs and other diagnostics that provide a more accurate picture of the conditions that led to death.
3. Should we undertake an independent autopsy?
If you have a strong belief that your loved one died under suspicious circumstance, you may want to consider an independent autopsy.
In my experience, detailed autopsies can complicate a cause of death analysis, providing more ammunition to the defense. They also tend to be expensive, ranging from $4,000 to $8,000 dollars. I rarely suggest such an option where my client’s loved one passes away in a hospital.
Death certificates are often generated quickly, typically on the day the patient passes away. If the certificate reflects a cause of death that is likely inaccurate, you will have a brief opportunity to conduct an autopsy before the burial. However, you must reach out to the funeral director immediately, explain the decision and make immediate arrangements for the physical autopsy, which can take place at the funeral home. Funeral directors can be a great source of information and they are usually motivated to help the family that is paying significant sums for the funeral services. They may have knowledge of other people who died at the local nursing home under circumstances suggesting neglect. Funeral home directors can also request an examination by the medical examiner if they believe it is warranted.
4. Should we contact the doctor completing the death certificate?
It is important that the doctor completing the death certificate understand that someone is looking over his shoulder during this process. Where my client’s loved one passes away in the hospital, I may have my client contact the doctor to discuss the process and highlight the facts that are relevant to the victim’s passing. They should be prepared to have a brief conversation, first asking if there is going to be an autopsy and then explaining their views about how the patient was impacted by the injury or neglect.
- Virginia law – when do we request an independent autopsy
As the below statute makes clear, where a resident dies from apparent trauma, accident or injury, a medical examiner should be notified. However, they have the authority, as they often do, to refuse to undertake an examination. In addition, if the healthcare provider does not believe the death was caused by trauma or injury, he or she may not make the referral.
I would recommend insisting on a medical examiner review any time the cause of death is unexpected or related to some trauma or fracture. In the first 6 months, hip fractures carry high rates of mortality from the fracture and related complications. A medical examiner will be more likely to consider all potential causes, as opposed to the immediate cause of death. In my experience, a medical examiner is more likely to reflect a hip fracture as a contributing cause of death than a treating healthcare provider, especially if that provider is affiliated with the facility that caused the hip fracture. Similarly, where a patient dies from an infection due to a pressure wound, a medical examiner is more likely to reflect the wound as a contributing cause of death.
1. Va. Code 32.1-263 (effective Jan 1, 2020)
263(C) The medical certification shall be completed and filed electronically with the State Registrar of Vital Records using the Electronic Death Registration System within 24 hours after death by the physician in charge of the patient’s care for the illness or condition which resulted in death except when inquiry or investigation by the Office of the Chief Medical Examiner is required by § 32.1-283 or 32.1-285.1, or by the physician that pronounces death pursuant to § 54.1-2972. If the death occurred while under the care of a hospice provider, the medical certification shall be completed by the decedent’s health care provider and filed electronically with the State Registrar of Vital Records using the Electronic Death Registration System for completion of the death certificate.
263 (D) When inquiry or investigation by the Office of the Chief Medical Examiner is required by § 32.1-283 or 32.1-285.1, the Chief Medical Examiner shall cause an investigation of the cause of death to be made and the medical certification portion of the death certificate to be completed and signed within 24 hours after being notified of the death. If the Office of the Chief Medical Examiner refuses jurisdiction, the physician last furnishing medical care to the deceased shall prepare and sign the medical certification portion of the death certificate.
2. Va. Code § 32.1-283 – Investigation required where death occurs from trauma, injury accident, or suddenly when in apparent good health…
A. Upon the death of any person from trauma, injury, violence, poisoning, accident, suicide or homicide, or suddenly when in apparent good health, or when unattended by a physician, or in jail, prison, other correctional institution or in police custody, or who is an individual receiving services in a state hospital or training center operated by the Department of Behavioral Health and Developmental Services, or suddenly as an apparent result of fire, or in any suspicious, unusual or unnatural manner, or the sudden death of any infant the Office of the Chief Medical Examiner shall be notified by the physician in attendance, hospital, law-enforcement officer, funeral director, or any other person having knowledge of such death . . (emphasis added)
B. Upon being notified of a death as provided in subsection A, the Office of the Chief Medical Examiner shall take charge of the dead body and the Chief Medical Examiner shall cause an investigation into the cause and manner of death to be made and a full report, which shall include written findings, to be prepared. In order to facilitate the investigation, the Office of the Chief Medical Examiner is authorized to inspect and copy the pertinent medical records of the decedent whose death is the subject of the investigation. Full directions as to the nature, character, and extent of the investigation to be made in such cases shall be furnished each medical examiner appointed pursuant to § 32.1-282 by the Office of the Chief Medical Examiner, together with appropriate forms for the required reports and instructions for their use
B. Death Certificates Findings Inadmissible Absent Doctor’s Foundation Testimony
- Edwards v. Jackson, 210 Va. 450, 171 S.E. 2d 854 (1970)
Error to admit death certificate findings without the foundation testimony of the doctor.
- Bailey v. Adm’x v. C.V. Hunter Inc, 207 Va 123, 148 S.E.2d 826 (1966)
While death certificate is prima facie evidence of the facts contained therein,
it is inadmissible to prove cause of death.
When it comes to navigating legal complexities, the choice of your attorney can significantly impact the outcome of your case. If you’re pursuing a Virginia Medical Malpractice case and require a dedicated advocate, consider reaching out to the Law Office of Jeffrey J. Downey for a no-cost consultation. With over thirty-five years of experience, Mr. Downey, a former defense attorney, possesses the trial expertise necessary to address complex malpractice disputes adeptly. The firm serves clients throughout Virginia, Maryland, and Washington D.C.
Mr. Downey has a proven track record of securing groundbreaking verdicts and establishing important legal precedents that benefit Plaintiffs in medical malpractice lawsuits. The firm is well-versed in handling a range of issues, including misdiagnosis, delayed diagnosis, nursing home negligence, surgical errors, patient abandonment, sexual misconduct or abuse, and failure to promptly address infections or serious medical conditions.
For those in need of legal guidance, visit https://www.jeffdowney.com/virginia-medical-malpractice-attorney/ to connect with a Virginia medical malpractice attorney and arrange a complimentary consultation. Your journey to justice begins with the right legal representation.
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